Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Two decades after the initial encouraging reports on plasmapheresis in myasthenia gravis, neurologic diseases represent the most common indication for therapeutic plasma exchange. Recent studies have not only established the therapeutic importance of plasmapheresis, but have also set new standards for the management of autoimmune neurologic disorders. Plasmapheresis has proved beneficial in autoimmune neurologic diseases such as Guillain-Barre syndrome, myasthenia gravis, and paraprotein-associated polyneuropathy. In some other diseases, e.g., multiple sclerosis, polymyositis, dermatomyositis, and chronic inflammatory demyelinating polyneuropathy, plasmapheresis cannot be considered a generally accepted therapeutic option. However, in chronic autoimmune diseases such as progressive multiple sclerosis, polymyositis, dermatomyositis, and chronic inflammatory demyelinating polyneuropathy, plasmapheresis is recommended in patients whose condition continues to worsen despite immunosuppressive drug therapies, and in those for whom it is desirable to reduce the dose of corticosteroids to avoid long-term complications. Based on the initial studies, plasmapheresis in conjunction with immunosuppressive drug therapies is now standard therapy for Eaton-Lambert syndrome.Dva desetljeća nakon početnih ohrabrujućih rezultata liječenja miastenije gravis pomoću plazmafereze, neurološke bolesti danas su najčešća indikacija za terapijsku izmjenu plazme. Plazmafereza je korisna metoda u liječenju autoimunih neuroloških bolesti poput Guillain-Barreova sindroma, miastenije gravis i polineuropatije uzrokovane paraproteinima. U nekim drugim neurološkim bolestima (multipla skleroza, polimiozitis, dermatomiozitis, kronična upalna demijelinizirajuća polineuropatija) plazmafereza nije općenito prihvaćeni način liječenja. Međutim, u kroničnim autoimunim bolestima kao što su multipla skleroza, polimiozitis, dermatomiozitis i kronična upalna demijelinizirajuća polineuropatija, plazmafereza se preporuča u bolesnika u kojih nije došlo do poboljšanja usprkos terapiji imunosupresivnim lijekovima, te u onih bolesnika u kojih je potrebno smanjiti dozu kortikosteroida kako bi se izbjegle komplikacije koje mogu nastati zbog dugotrajne terapije. Plazmafereza i imunosupresivni lijekovi danas su standardna terapija za Eaton-Lambertov sindrom
